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Shurtleff HA, Poliakov A, Barry D, et al. A clinically applicable functional MRI memory paradigm for use with pediatric patients. Epilepsy Behav. 2021;126:108461doi: 10.1016/j.yebeh.2021.108461.
Shurtleff, H. A., Poliakov, A., Barry, D., Wright, J. N., Warner, M. H., Novotny, E. J., Marashly, A., Buckley, R., Goldstein, H. E., Hauptman, J. S., Ojemann, J. G., & Shaw, D. W. W. (2022). A clinically applicable functional MRI memory paradigm for use with pediatric patients. Epilepsy & behavior : E&B, 126108461. https://doi.org/10.1016/j.yebeh.2021.108461
Shurtleff, Hillary A, et al. "A clinically applicable functional MRI memory paradigm for use with pediatric patients." Epilepsy & behavior : E&B vol. 126 (2022): 108461. doi: https://doi.org/10.1016/j.yebeh.2021.108461
Shurtleff HA, Poliakov A, Barry D, Wright JN, Warner MH, Novotny EJ, Marashly A, Buckley R, Goldstein HE, Hauptman JS, Ojemann JG, Shaw DWW. A clinically applicable functional MRI memory paradigm for use with pediatric patients. Epilepsy Behav. 2022 Jan;126:108461. doi: 10.1016/j.yebeh.2021.108461. Epub 2021 Dec 09. PMID: 34896785.
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Epilepsy Behav. 2022 Jan;126:108461. doi: 10.1016/j.yebeh.2021.108461. Epub 2021 Dec 09.

A clinically applicable functional MRI memory paradigm for use with pediatric patients.

Epilepsy & behavior : E&B

Hillary A Shurtleff, Andrew Poliakov, Dwight Barry, Jason N Wright, Molly H Warner, Edward J Novotny, Ahmad Marashly, Robert Buckley, Hannah E Goldstein, Jason S Hauptman, Jeffrey G Ojemann, Dennis W W Shaw

Affiliations

  1. Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States. Electronic address: [email protected].
  2. Radiology, Seattle Children's Hospital, United States.
  3. Clinical Analytics, Seattle Children's Hospital, United States.
  4. Radiology, Seattle Children's Hospital, United States; Department of Radiology, University of Washington School of Medicine, United States.
  5. Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States.
  6. Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States; Neurology, Seattle Children's Hospital, United States; Department of Neurology, University of Washington School of Medicine, United States.
  7. Department of Neurological Surgery, University of Washington School of Medicine, United States.
  8. Neurosciences Institute, Seattle Children's Hospital, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States.
  9. Neurosciences Institute, Seattle Children's Hospital, United States; Center for Integrated Brain Research Seattle Children's, United States; Department of Neurological Surgery, University of Washington School of Medicine, United States; Neurological Surgery, Seattle Children's Hospital, United States.

PMID: 34896785 DOI: 10.1016/j.yebeh.2021.108461

Abstract

OBJECTIVE: Clinically employable functional MRI (fMRI) memory paradigms are not yet established for pediatric patient epilepsy surgery workups. Seeking to establish such a paradigm, we evaluated the effectiveness of memory fMRI tasks we developed by quantifying individual activation in a clinical pediatric setting, analyzing patterns of activation relative to the side of temporal lobe (TL) pathology, and comparing fMRI and Wada test results.

METHODS: We retrospectively identified 72 patients aged 6.7-20.9 years with pathology (seizure focus and/or tumor) limited to the TL who had attempted memory and language fMRI tasks over a 9-year period as part of presurgical workups. Memory fMRI tasks required visualization of autobiographical memories in a block design alternating with covert counting. Language fMRI protocols involved verb and sentence generation. Scans were both qualitatively interpreted and quantitatively assessed for blood oxygenation level dependent (BOLD) signal change using region of interest (ROI) masks. We calculated the percentage of successfully scanned individual cases, compared 2 memory task activation masks in cases with left versus right TL pathology, and compared fMRI with Wada tests when available. Patients who had viable fMRI and Wada tests had generally concordant results.

RESULTS: Of the 72 cases, 60 (83%), aged 7.6-20.9 years, successfully performed the memory fMRI tasks and 12 (17%) failed. Eleven of 12 unsuccessful scans were due to motion and/or inability to perform the tasks, and the success of a twelfth was indeterminate due to orthodontic metal artifact. Seven of the successful 60 cases had distorted anatomy that precluded employing predetermined masks for quantitative analysis. Successful fMRI memory studies showed bilateral mesial temporal activation and quantitatively demonstrated: (1) left activation (L-ACT) less than right activation (R-ACT) in cases with left temporal lobe (L-TL) pathology, (2) nonsignificant R-ACT less than L-ACT in cases with right temporal lobe (R-TL) pathology, and (3) lower L-ACT plus R-ACT activation for cases with L-TL versus R-TL pathology. Patients who had viable fMRI and Wada tests had generally concordant results.

SIGNIFICANCE: This study demonstrates evidence of an fMRI memory task paradigm that elicits reliable activation at the individual level and can generally be accomplished in clinically involved pediatric patients. This autobiographical memory paradigm showed activation in mesial TL structures, and cases with left compared to right TL pathology showed differences in activation consistent with extant literature in TL epilepsy. Further studies will be required to assess outcome prediction.

Copyright © 2021 Elsevier Inc. All rights reserved.

Keywords: Epilepsy surgery; Hippocampus; Temporal lobe epilepsy; Tumor; fMRI

Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jason S. Hauptman, MD, PhD, ser

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